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July 2011, Volume 41 Number 7 , p 10 - 11



Under a new policy, my hospital won't hire anyone-including a nurse-who smokes, even if the applicant agrees not to smoke on the premises. Is this legal? It seems unfair to discriminate against someone for a legal activity conducted on private time.-S.N., GA.The short answer is yes, it's legal in "right to work" states such as yours. Employers have the right to set terms of employment as long as they don't discriminate against a protected class, such as members of a racial minority or people with disabilities.Refusing to hire smokers is a growing trend among healthcare employers. One reason is financial: Smokers add to a facility's insurance costs because they tend to have more health problems than nonsmokers. In addition, most healthcare facilities have a mission to promote healthy behaviors, and this policy supports that mission.I'm in the middle of a lawsuit involving a patient who was treated for a drug overdose in the ED. Over the patient's objections, the ED physician verbally ordered a nasogastric (NG) tube. I took the order and documented it appropriately, but the physician refused to sign it. I didn't document this refusal in the medical record, but I reported the incident in writing to the risk manager.Now that the patient is suing everyone for assault and battery, the physician is claiming he never gave the order. At a deposition, the plaintiff's lawyer asked why I didn't document the physician's alleged refusal to sign his order in the medical record. I replied that the medical record isn't the place to "point fingers" at other professionals. Was I wrong to omit this information?-K.M., MD.You're correct that the medical record should document objective information pertaining to the patient's condition and care, not disputes among staff. But this situation falls into a gray area. Because the medical record should tell the complete story of a patient's care, our legal consultant believes that documenting both the verbal order and the physician's subsequent

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